Department of Pediatrics, Chungnam National University Hospital, Daejeon, South Korea.
Pediatr Neurol. 2011 Jun;44(6):433-8. doi: 10.1016/j.pediatrneurol.2011.01.007.
We analyzed acute neurotoxic problems attributable to chemotherapy or immunosuppression in the context of childhood neoplastic diseases, based on clinical and neuroradiologic findings. This retrospective single-center study reviewed the acute neurologic complications of 62 children receiving conventional chemotherapy or hematopoietic stem cell transplantation from July 2005-July 2008. We excluded patients with central nervous system metastasis and various neurotoxic manifestations not usually requiring cranial magnetic resonance imaging. Of 62 patients, 12 (19.3%) developed acute neurologic complications. The most common complications included posterior reversible encephalopathy syndrome in six of 12 (50%) patients, and Wernicke's encephalopathy in three of 12 (25%) patients. Other complications included chemical arachnoiditis, grey matter injury induced by postchemotherapeutic angiopathy, and leukoencephalopathy. Posterior reversible encephalopathy syndrome was accompanied by hypertensive episodes in most patients (5/6), and Wernicke's encephalopathy was evident with altered mental status in malnourished children. These data indicate that posterior reversible encephalopathy syndrome and Wernicke's encephalopathy are the predominant complications in children undergoing chemotherapy or hematopoietic stem cell transplantation. Early radiologic and clinical evaluation and prompt treatment for these complications are necessary to prevent their progression to irreversible brain damage.
我们根据临床和神经影像学发现，分析了儿童肿瘤疾病患者接受化疗或免疫抑制治疗后出现的急性神经毒性问题。这项回顾性单中心研究分析了 2005 年 7 月至 2008 年 7 月期间接受常规化疗或造血干细胞移植的 62 名儿童的急性神经系统并发症。我们排除了中枢神经系统转移和各种通常不需要颅磁共振成像的神经毒性表现的患者。在 62 名患者中，有 12 名（19.3%）出现了急性神经系统并发症。最常见的并发症包括 12 例中的 6 例（50%）后可逆性脑病综合征和 12 例中的 3 例（25%）Wernicke 脑病。其他并发症包括化学性蛛网膜炎、化疗后血管病引起的灰质损伤和脑白质病。在后可逆性脑病综合征中，大多数患者（5/6）伴有高血压发作，而在营养不良的儿童中，Wernicke 脑病表现为精神状态改变。这些数据表明，在后可逆性脑病综合征和 Wernicke 脑病是接受化疗或造血干细胞移植的儿童中主要的并发症。早期的影像学和临床评估以及对这些并发症的及时治疗对于预防其进展为不可逆性脑损伤是必要的。
